Part B Insider (Multispecialty) Coding Alert

Published on Fri Jun 21, 2013 PDF

Plus: Don’t attempt to adjust redetermined claims.

Make sure your physician’s terminal illness documentation is up to snuff for hospice claims, or you may lose your rightful reimbursement. In a recent probe, Medicare Administrative Contractor NHIC conducted probes of hospice claims in their first, second, and third benefit periods. Reviewers denied 31 percent of claims for the first and second period, and 27 percent of claims in the third period.

Results: Lack of valid physician certification was the top denial reason (43 percent) for first period claims, timely physician cert/recert was second(20 percent), and terminal prognosis was third(19 percent). In second and third periods, terminal prognosis moved to the top denial reason spot (41and 50 percent, respectively). Lack of valid physician certification moved to the second spot (31 and 33 percent, respectively). Untimely physiciancert/recert dropped sharply to 3 and 8 percent,respectively.

You can read the complete article at www.medicarenhic.com/providers/articles/RHHIProbe061313.pdf